Phoniatric aspects in cleft lip patients.

Multidisciplinary care for patients with clefts includes surgical correction of the facial disfigurement and optimizing the quality of speech to improve the social integration of the affected patient. This work summarizes the knowledge of communicational aspects of cleft lip (CL) patients. Cleft-type speech characteristics can be described as "passive" obligatory errors resulting from the anatomical defect and "active" compensation efforts. Long-lasting phonological deficits in patients with clefts may be due to the fact that their development is affected by abnormal learned neuromotor patterns as a consequence of these two mechanisms. Surgery alone will not modify active cleft-type characteristics whereas speech therapy should lead to an improvement. Passive characteristics are usually assessed by speech therapy but surgery may facilitate the progress. From the phoniatrician's point of view, rhinophonia in (secondary lip and septo-) rhinoplasty (and surgery of the nasal sinuses) in CL patients has to be assessed in no other way than in patients without a cleft. Pragmatic skills, that is, using verbal speech in a social context, cognition, and the acquisition of emotional, behavioral, and social interaction patterns may be affected in patients with isolated CLs. As a consequence these individuals are at high risk to develop emotional disorders. So speech developmental disorders in a narrow sense are of minor importance in individuals with an isolated CL when comparing them with patients with CL and palate. Communication disorders in these patients seem not to result from phonological defects but from psychological problems that may influence the entire development of an affected child. The literature shows that there is a need to collect more data on the issue of psychological and social problems in patients with an isolated CL for clinical and scientific purposes.